Search PubMed⌕ Search

Biomedical subjects

K Borch

Publications and source records attributed to K Borch.

At least 73 records · Page 4Linked to original sources
PubMed1991

H+,K-ATPase antibodies in autoimmune gastritis: observations on the development of pernicious anemia.

The prevalence and development of antibodies to H+,K+-ATPase were investigated with a sensitive enzyme-linked immunosorbent assay in 86 patients with autoimmune atrophic gastritis (type A). Sixty-nine of the patients had pernicious anemia, and 17 had simple atrophic gastritis. Elevated titers were found in 93% of pernicious anemia probands. Women had higher levels than men: 3.24 versus 1.58 U/l (p = 0.002) (upper reference limit, 0.55 U/l). The antibody levels did not change over 1-4 years, but a gradual decrease in titers over decades was observed. All patients with pernicious anemia had low levels of pepsinogen A, a product of the gastric chief and mucous neck cells (median, 8.5 micrograms/l; reference range, 10-90 percentile, 64.4-195.5 micrograms/l), and elevated serum gastrin values (greater than 55 pmol/l) were found in 87%. Serum pepsinogen A, but not serum gastrin, correlated with H+,K(+)-ATPase antibody titers (r = 0.35, p = 0.01). In the 17 cases with simple atrophic gastritis, H+,K(+)-ATPase antibodies correlated inversely with fundic mucosal gland destruction. The data indicate that H+,K(+)-ATPase antibody titers reflect the immune responsiveness of a given patient as well as the antigenic amount, dependent on the degree of mucosal destruction and the duration of the disease.

Adult↗
PubMed1991

Long-term follow-up of patients with gallbladder in situ after endoscopic sphincterotomy for choledocholithiasis.

Endoscopic sphincterotomy (EST) was performed on 148 patients with common bile duct stones and intact gallbladder. The duct was cleared in 130 cases (88%). Immediate complications occurred in 23 patients (15.5%), six of whom died. In 118 of the 139 patients discharged from the hospital, the bile ducts were cleared and the gallbladder in situ. The median observation time in these 118 cases was 42 (1-97) months, during which 13 (11%) were cholecystectomized because of symptoms or acute complications due to remaining gallbladder stones, and 49 (42%) died 2-87 (median 24) months after EST. The probability (life-table) of remaining free from cholecystectomy-requiring symptoms or complications was 0.87 after 42 months. There was no association between nonfilling of the gallbladder at ERC and subsequent problems with gallbladder stones. EST for choledocholithiasis with retained gallbladder is justified for elderly and frail patients. Indefinite postponement of cholecystectomy may be warrantable, restricting surgery to patients with symptoms from gallbladder stones. This most frequently means within 2 years after EST.

Acute Disease↗
PubMed1991

Evaluation of preoperative computed tomography in gastric malignancy.

Ninety patients with gastric malignancy underwent computed tomography (CT) before surgery. The CT findings regarding neoplastic invasion of adjacent organs and metastasis or enlarged lymph nodes were compared with the findings at laparotomy (85 cases) or autopsy (5 cases), thus permitting evaluation of the diagnostic accuracy of CT and its usefulness for predicting resectability. When present, neoplastic invasion of adjacent organs was overestimated or underestimated by CT in 21 cases. Invasion of adjacent organs according to CT was false positive in 17 cases and false negative in 11 cases. When liver metastasis or enlarged regional or distant lymph nodes were present, CT overestimated or underestimated their extent in 17 cases, and the diagnosis was false positive in one case and false negative in 33 cases. The positive and negative predictive values of CT concerning resectability of the tumor were 81% and 64%, respectively. Routine preoperative CT in gastric malignancy is concluded to be of limited value and surgical exploration, when feasible, remains the method of choice.

Aged↗
PubMed1990

Extracorporeal shock-wave lithotripsy of bile-duct stones. Initial Swedish experience.

Fifteen patients with mean age 74 (range 34-94) years were treated with extracorporeal shock-wave lithotripsy (ESWL) for bile-duct stones (intrahepatic in 4 cases) following failure of surgical or endoscopic treatment. A Dornier HM3 lithotriptor was used, and in all cases the ESWL session was preceded by establishment of external biliary drainage (endoscopic nasobiliary in 9, percutaneous transhepatic in 2 and a surgical T-tube in 4 cases) for radiologic positioning of stone. Endoscopic (14 cases) or surgical (1 case) sphincterotomy was done to facilitate spontaneous passage or endoscopic removal of fragments after ESWL. General anesthesia was not needed during the average 50 (range 25-65) min required for performance of ESWL. The number of delivered discharges was 750 to 2,100 and the generator voltage varied from 14 to 17 kV. Disintegration of stone was good in 12 cases and partial in two. Ten patients remain stone-free, five after spontaneous passage, and five after endoscopic extraction of fragments. There were few complications. ESWL may be useful in high-risk patients with failed endoscopic treatment of bile-duct stones and for management of intrahepatic stones.

Adult↗
PubMed1989

A new case with hereditary xanthinuria: response to exercise.

The concentration of purines in plasma and urine from a 37-yr-old healthy man with a very low plasma urate concentration was measured by HPLC. A persistent increase in xanthine and a slight elevation of hypoxanthine was found. The metabolic response to intensive treadmill running and long distance running was investigated. The hypoxanthine concentration increased to about the same level as in healthy controls, but the elimination from plasma was considerably slower. The high xanthine level was practically unchanged by exercise.

Adult↗
PubMed1989

Progastrin processing during antral G-cell hypersecretion in humans.

Using radioimmunoassays specific for essential processing sites of human progastrin in combination with chromatography before and after cleavage with trypsin and carboxypeptidase B, we have examined antral biopsy specimens and serum from 10 hypergastrinemic patients with fundic atrophic gastritis and 7 normal control subjects. Four types of processing were studied: N-terminal proteolysis (at the N-terminus of component I, gastrin 34, and gastrin 17); C-terminal proteolysis (at the C-terminus of the amide donor, glycine93 in preprogastrin); alpha-carboxyamidation (of phenylalanine92); and O-sulfation (of tyrosine87). The results show that progastrin during permanent G-cell hypersecretion is less completely processed with respect to C-terminal proteolysis, alpha-amidation, and tyrosine-sulfation. In contrast, the degree of N-terminal proteolysis is normal. Thus, the processing of progastrin adjacent to the active site of gastrin is more restrictively controlled than N-terminal processing during G-cell hypersecretion associated with pernicious anemia.

Carboxypeptidase B↗
PubMed1989

The ratio of pepsinogen A to pepsinogen C: a sensitive test for atrophic gastritis.

To diagnose fundic atrophic (type A) gastritis as part of the clinical investigation of various diseases or for epidemiologic purposes, a simple and reliable diagnostic test would be of great value. We studied circulating levels of pepsinogen A (PGA) and pepsinogen C (PGC) in 179 patients with fundic atrophic gastritis, 29 unselected patients with gastric adenocarcinoma, 15 totally gastrectomized patients, and 50 gastroscopically examined normal controls. Of 147 patients with severe atrophic gastritis, 42 (29%) had serum PGA and 22 (15%) serum PGC values within the range of those in totally gastrectomized patients. The most sensitive test for fundic atrophic gastritis was the PGA/PGC ratio in serum, the sensitivity and specificity being 99% and 94%, respectively (discrimination limit, 5.5). Correspondingly, the positive predictive value was 98%, and the negative predictive value 98%. Of 29 unselected patients with gastric adenocarcinoma 22 (76%) had serum PGA/PGC values lower than the discrimination limit for atrophic gastritis. We conclude that the relatively simple analysis of PGA and PGC in serum is a powerful test for fundic atrophic gastritis with several potential areas of application.

Adenocarcinoma↗
PubMed1989

Atrophic gastritis and gastric carcinoid tumours.

During recent decades an increasing number of case reports have pointed at a relation between atrophic gastritis type A and gastric carcinoid. This relation has now been quantitatively documented in endoscopic screening studies. Among patients with pernicious anaemia the prevalence of gastric carcinoid was 2-9%. Many of these carcinoids, however, remain subclinical. The majority are broadbased polypoid tumours. Most are situated in the gastric body or fundus. Of 95 patients with atrophic gastritis and gastric carcinoid reported in the literature, 60 (63%) had multicentric tumours and 13 (14%) lymph node and/or hepatic metastases. Microscopically, the tumours, which are frequently of the enterochromaffin-like cell type, show various structural differentiations, glandular differentiation indicating malignant potential. Purely intramucosal carcinoids have been described. The precurser lesion to such "early carcinoids", as well as to infiltrating carcinoids, is probably hyperplasia of endocrine cells in the atrophic fundic mucosa. Such hyperplasias, whether nodular or diffuse, are quantitatively related to hypergastrinaemia, which is a typical feature of antrum sparing (type A) atrophic gastritis. Most tumours can be treated endoscopically, although antrectomy with abolition of hypergastrinemia may be the definitive treatment. It seems that the risk of developing gastric carcinoid 'per se' does not justify regular gastric screening in patients with type A atrophic gastritis. However, as these patients also run an increased risk of developing several benign diseases, gastric adenocarcinoma, and probably also pancreatic malignancy, regular survey in selected cases is indicated.

Carcinoid Tumor↗
PubMed1989

Long-term follow-up after endoscopic management of retained and recurrent common duct stones.

Endoscopic sphincterotomy (EST) was attempted on 128 patients because of retained or recurrent common bile duct stones. The duct was cleared in 118 cases (92%). Early complications arose after 27 (16.5%) of 164 sphincterotomies, with haemorrhage most common. Emergency laparotomy was performed in four cases. There were four deaths within a month of EST, two of them directly attributable to EST. In seven of the 118 patients with successful EST late complications (stenosis and/or recurrent stone) appeared during a median follow-up of 57 (range 24-101) months (after less than 2 years in 6 cases). Restenosis and new stones could usually be endoscopically treated. Ascending cholangitis was not a problem, provided that the bile flow was unobstructed. EST is relatively safe, and must now be considered the procedure of choice for postcholecystectomy choledocholithiasis especially in elderly or high-risk patients. EST in young, fit patients is more controversial, and requires further detailed longitudinal analyses.

Adult↗
PubMed1988

Haemorrhagic gastritis. Incidence, etiological factors, and prognosis.

Etiological factors and prognosis were analyzed in 78 patients with haemorrhagic gastritis admitted to an intensive care unit during 8 years. These patients constituted 11.4% of a total of 684 cases with massive upper gastrointestinal haemorrhage admitted during the same time period. The annual incidence of haemorrhagic gastritis was 6.5/100,000 inhabitants. Most frequently, the bleeding episode was associated with intake of alcohol (35%) or anti-inflammatory drugs (23%). Only 4 patients (5%) had classical stress ulcers. Due to massive bleeding, surgery was necessary in 5 patients. Non-resectional surgery was carried out with no postoperative mortality. Six patients (8%) died (age 72-92 years), one as a direct cause of bleeding and five in severe associated disease, haemorrhagic gastritis being more or less a terminal event. Thus, in the great majority of unselected patients with haemorrhagic gastritis bleeding ceases on conservative treatment. In a minor fraction surgical treatment is a last resort but the method of choice is debatable. We propose that gastric resection should be avoided.

Adult↗
PubMed1988

Gallbladder cancer: current status in clinical practice.

A total series of 68 unselected patients with gallbladder cancer, diagnosed during 1972 to 1981, was studied retrospectively. In 61 cases (90%), the diagnosis was histologically verified. The cardinal symptoms were local pain (87%), loss of weight (53%), and jaundice (59%). The diagnosis was established after autopsy in 22 patients (32%), and exploratory laparotomy in 22 patients (32%). Palliative surgery was carried out in 26 patients of whom seven (27%) died postoperatively. Only one patient, with an incidentally detected cancer at routine cholecystectomy, was treated radically. Four out of nine patients died within one month after PTC-drainage. The mean survival time for the whole series was 2.9 months. The longest survival was 21 months. Considering the increasing incidence of gallbladder cancer in Sweden, as well as of other cancers of the biliary system, these findings emphasize the need for intensified research. An epidemiological approach studying the correlation of gallbladder cancer with the changing trend of gallstone disease and its treatment would perhaps be fruitful.

Adult↗
PubMed1987

Gastric carcinoid associated with the syndrome of hypergastrinemic atrophic gastritis. A prospective analysis of 11 cases.

The prevalence of gastric carcinoid in fundic atrophic gastritis is probably greater than previously recognized. To help elucidate the clinicopathology of this syndrome, we report a series of 11 patients with solitary or multicentric carcinoid tumors. In these patients, basal gastrin levels and density of fundic mucosal endocrine cells were greater than that for patients with uncomplicated fundic atrophic gastritis (p = 0.02 and p = 0.002, respectively). The polypoid tumors, of which the largest measured 30 mm, frequently showed characteristic endoscopic features. They were all situated in the fundic mucosa, which showed micronodular endocrine cell hyperplasia. Small, endoscopically evident tumorlets, or "early carcinoids," limited to the lamina propria were observed in some patients. These lesions may represent intermediate stages between micronodules and invasive carcinoids, all of which infiltrated at least into the muscularis mucosae of the gastric wall. Although some consistent characteristics features were noted, there were structural variations. The cells were argyrophil but nonargentaffin and did not stain with conventional mucus stains. They did not stain significantly for carcinoembryonic antigen (CEA). The secretory product of these tumors remains to be identified. Ultrastructurally, some tumors were mainly composed of enterochromaffinlike (ECL) cells, but in other tumors most of the cells could not be classified.

Carcinoid Tumor↗
PubMed1987

Evaluation of gastric carcinoembryonic antigen analysis as an aid during screening for gastric neoplasia in atrophic gastritis.

The value of gastric juice and tissue carcinoembryonic antigen (CEA) analysis as an adjunct to endoscopic screening for gastric neoplasia was investigated in 61 patients with atrophic gastritis of whom 41 had other (superimposed) gastric lesions: six adenocarcinoma, four carcinoid, 23 regenerative polyps with or without dysplasia and eight fundic, or antral mucosal dysplasia. The gastric concentration of CEA did not differ between patient groups with different superimposed lesions. In these patients the gastric juice CEA concentrations were significantly increased in comparison with those in patients without superimposed lesions (p = 0.002). Gastric juice CEA concentrations above the upper range (+2SD) of those observed in normal controls were found in 40 (98%) of 41 patients with superimposed lesions and in 13 (65%) of 20 patients without such lesions (p = 0.001). At re-examination of 26 patients without neoplasia initially, after a mean interval of 32 months two (without polyps initially), had developed regenerative polyps, one an adenoma, and one an adenocarcinoma. These four had raised gastric juice CEA concentrations at the initial examination.

Adult↗
PubMed1987

Evaluation of cimetidine as an aid in the management of non-variceal massive upper gastrointestinal haemorrhage.

In order to evaluate the effect of H2-receptor blockade as an adjunct to antacid treatment in non-variceal massive upper gastrointestinal haemorrhage, 106 patients were randomized to treatment with either antacid (n = 54) or cimetidine and antacid (n = 52). One patient (antacid group) died as a direct cause of bleeding. Acute surgery was carried out in 8 patients (14.8%) in the antacid group and in 4 patients (7.7%) in the cimetidine-antacid group. Continuous bleeding or re-bleeding occurred in 11 patients (20.4%) in the antacid group and in 10 patients (19.2%) in the cimetidine-antacid group. Neither these differences, nor any differences related to specific source of bleeding, were statistically significant. It is concluded that, according to the regimen applied in the present study, treatment with cimetidine does not to any significant extent influence the immediate outcome for patients with non-variceal massive upper gastrointestinal haemorrhage.

Adult↗
PubMed1986

Endocrine cell proliferation and carcinoid development: a review of new aspects of hypergastrinaemic atrophic gastritis.

The accumulating evidence of an association between antrum-sparing hypergastrinaemic atrophic gastritis, frequently associated with pernicious anaemia, and the occurrence of gastric carcinoid tumours is briefly reviewed. The development of argyrophil cell carcinoid tumours in the atrophic fundic mucosa seems to be related to argyrophil cell hyperplasia caused by hypergastrinaemia. Epidemiologic considerations indicate that the gastric carcinoid generally is underdiagnosed and that the incidence of this tumour is higher than previously recognized. The clinical relevance of minute gastric carcinoids, or endocrine cell 'adenomas', is obscure. However, larger tumours should be regarded as potentially malignant. These findings are relevant to the aspect of long-term medically induced achlorhydria leading to hypergastrinaemia.

Achlorhydria↗
PubMed1986

Relations between circulating gastrin and endocrine cell proliferation in the atrophic gastric fundic mucosa.

It has been suggested that gastrin may be a causative factor in the proliferation of gastric fundic mucosal endocrine cells, as seen in the Zollinger-Ellison syndrome and in atrophic gastritis with hypergastrinemia of antral origin. In the present study, morphometrically determined densities of endocrine cells in fundic mucosal biopsy specimens were related to basal levels of serum gastrin in 10 normal controls and 60 patients with achlorhydric fundic atrophic gastritis, of which 45 had pernicious anemia (5 with fundic mucosal carcinoid) and 15 had atrophic gastritis without pernicious anemia. The densities of fundic mucosal endocrine cells were positively related to the levels of serum gastrin (atrophic gastritis, rs = 0.65; atrophic gastritis and normal controls, rs = 0.72). The highest levels of serum gastrin were found in patients with carcinoid tumors (mean, 1659.3 pmol/l), followed by those in patients with focal hyperplasias (cluster formation) of endocrine cells (mean, 503.2 pmol/l) and those in patients without focal hyperplasias (mean, 304.4 pmol/l) (p = 0.03 and p = 0.04, respectively).

Adult↗
PubMed1986

Epidemiologic, clinicopathologic, and economic aspects of gastroscopic screening of patients with pernicious anemia.

In a well-defined population with a known prevalence of pernicious anemia (PA), gastroscopic screening was performed in 123 patients with PA, of whom 61 were rescreened after a mean time interval of 32 months. At the primary screening the prevalence of gastric neoplasia was 8.1% and that of gastric malignancy 4.1%. No neoplasias or malignancies were diagnosed at re-screening. The estimated cost per gastric neoplasia diagnosed during primary screening was USD 850 and that per diagnosed malignancy USD 1700. Adenoma, one with early adenocarcinoma, was diagnosed in two patients, primary early adenocarcinoma in two patients, and advanced adenocarcinoma in one patient. Five patients had gastric fundic mucosal carcinoid, of which one was multicentric with a regional metastasis. Gastric carcinoids most probably are underdiagnosed in atrophic gastritis, and, when small and solitary, their clinical relevance is uncertain. Fundic mucosal endocrine cell hyperplasia and hypergastrinemia seem to be important factors in their development.

Adenocarcinoma↗